Healthcare Provider Details

I. General information

NPI: 1164063681
Provider Name (Legal Business Name): KAREN ANDERSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5612 EASTON ROAD
PLUMSTEADVILLE PA
18949-0866
US

IV. Provider business mailing address

PO BOX 82430
PHILADELPHIA PA
19182-4320
US

V. Phone/Fax

Practice location:
  • Phone: 215-766-8844
  • Fax: 215-766-0733
Mailing address:
  • Phone: 215-762-0810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09191489
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: